GASTROINTESTINAL
BEST INITIAL TEST FOR: DYSPHAGIA/ODYNOPHAGIA
OROPHARYNGEAL:
MODIFIED BARIUM SWALLOW
ESOPHAGEAL PYSPHAGIA:
EGD
HEMOPHILIA (BEST INITIAL TEST AND TREATMENT)
MIXING STUDY *MOST ACCURATE- OBTAIN SPECIFIC FACTOR ASSAYS FOR FACTORS VII, VIII, IX, XI, XII
TREATMENT: TRANSFUSE MISSING FACTOR,CRYOPRECIPITATE, DESMOPRESSIN
Tuberculosis- Best initial and treatment
Best Inital Test: Sputum acid-fast stain
Most Accurate Test: Mycobacterial Culture of Putum
Treatment: Respiratory isolation, INH, pyrazinamide, rifampin, ethambutol, vitamin B6
COMPARTMENT SYNDROME
Dx: Clinical + calculate delta pressure- compartment pressure; + if delta pressure < 30 mm
Tx: Immediate fasciotomy to decrease pressures and increase tissue perfusion
Cauda Equina Syndrome
Dx: Presents with saddle anesthesia, bowel, or bladder incontinence, hyporeflexia, asymettric muscle weakness
TREATMENT FOR CANDIDA ALBICANS
FLUCONAZOLE P.O.
DESMOPRESSIN
AVOID ASA, NSAIDS, PLATELET FUNCTION INHIBITORS
Aspergillosis
TX: Oral corticosteroids, add itraconazole
Carpal Tunnel
Tx: Best Initial: Splint the wrist in a neutral position at night and during the day if possible
Medical: Corticosteroid injection of the carpal canal and NSAIDs
Most Definitive treatment: decompressing the tunnel is a widely accepted treatment, particularly for fixed sensory loss.
STROKE
Dx: Best initial step: Head CT w/out contrast, labs, CBC, PT/PTT, cardiac enzymes and troponin and BUN/ creatine. Diffusion weighted MRI
Cardioembolic: ECG, Echocardiogram, Holter Monitor
Thrombotic: Carotid Ultrasonography, MRA, CTA, Doppler, Angiography
Tx: thrombolytics, ASA, monitor
TREATMENT FOR HERPES SIMPLEX VIRUS
HYPERCOAGULABLE STATES ( BEST INITIAL TEST, TREATMENT)
THROMBOLPHILIA SCREENING, LAB TESTS
TREATMENT: HEPARIN IMMEDIATELY FOLLOWED BY 3-6 MONTHS OF WARFARIN
Aspergilloma
Dx: CXR or CT reveals solid mass within a preexisting lung Cavity
Treatment: If symptomatic, itraconazole or curative surgical resection
Patellofermoral Pain syndrome
Dx: Clinical. Needle aspiration is indicated if septic bursitis is suspected. No labs or imaging needed.
Tx: Best initial treatment: Rest, heat and ice, elevation, and NSAIDs
*intrabursal corticosteroud injection an be considered
Subarachnoid Hemorrhage
Dx: Immediate head CT w/out contrast, Lumbar puncture, 4 vessel angiography
Tx: Most Definitive: Neurosurgery, may perform angiographic coiling and/or stenting to stabilize aneurysm. Prevent rebleeding by maintaining BP< 150 mm Hg
CYTOMEGALOVIRUS
GANCICLOVIR IV
DISSEMINATED INTRAVASCULAR COAGULATION
DIAGNOSIS AND TREATMENT?
LAB TEST- INCREASED PT AND PTT DECREASE PLATELETS
TREATMENT: REVERSE THE UNDERLYING CAUSE; TRANSFUSE RBCS, PLATELETS, AND FFP, AND MANAGE SHOCK AS NECESSARY
Chronic Necrotizing Pulmonary Aspergillosis
Treatment: Voriconazole, surgical resection
Tendinitis
Dx: Clinical, ultrasound, MRI
Tx: Best initial Treatment: Rest, NSAIDS, ice for first 24-48 hours
Next best treatment: corticosteroid injection
Intracerebral Hermorrhage
Dx: Immediate noncontrast head CT. Look for hyperdense areas, mass effect, or edema.
Tx: Monitor for signs of rebleed, shift and possible herniation. Herniation is a medical emergency.
TREATMENT FOR DISTAL ESOPHAGEAL SPASM
CALCIUM CHANNEL BLOCKERS, TCAS, NITRATES
SEVERE: SURGERY- ESOPHAGEAL MYOTOMY
THROMBOTIC THROMBOCYTOPENIC PURPURA
Lab Tests- Decreased Platelets and Hb, increase creatine
Blood Film: Presence of schistocytes (fragmented RBCs)
Treatment: TTP- Plasma Exchange
HUS- Dialysis for AKI may be needed. Plasma exchange
INVASIVE ASPERGILLOSIS
Dx: SERUM GALACTOMANNAN ASSAY, LUNG BIOPSY SHOULD BE PERFORMED IF NEGATIVE
Tx: VORICONAZOLE OR CASPOFUNGIN IN ADDITION TO DECREASING IMMUNOSUPPRESSANT THERAPY
Herniated Disk
Dx: + passive straight leg raise
Imaging: MRI
Adtl: Obtain an ESR and plain xray
Tx: Best Initial: Nsaids PT, local heat
Most definitive: Surgery
Dx: MRI with gadolinium and MR venography. CT angiography and CT venography are acceptable.
Tx: broad-spectrum antibiotics: Vancomycin + third or fourth generation cephalosporin (ceftriax-one or cefepime).
IV antibiotics recommended for 3-4 weeks
Surgical drainage may be necessary